The environment of clinical trial for new drug development in our country is stagnating in quality and quantity due to acceptance of foreign clinical data and strengthening of restrictions (new GCP) and other reasons, and it is an urgent issue to activate clinical trials. The Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology (MECSST) were planning an activation of clinical trials. Under this program, they have promoted training of clinical trial coordinators at medical organizations with cooperation of the Japan Medical Association, and construction of a large-scale trial network connecting multiple medical institutions. Its results have been gradually recognized, but clinical trials still cost several times higher than in the West. In order to improve this situation, it is imperative to construct a thorough system from electronic patient records as a source of information through clinical trials, and to realize more efficient, high quality and inexpensive clinical trials. This is a report of our development of a system that ensures security and authenticity of not only electronic patient records but also data among databases of laboratories, Contract Research Organizations (CROs), physicians, pharmacists, nurses and many other specialists, by integrating electronic authentication and electronic signature through the Web technology and Healthcare Public Key Infrastructure (HPKI).

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 Recently, delivery service of DICOM (digital imaging and communications in medicine) images from a picture archiving and communication system (PACS) through intrahospital network has been considered to be necessary for the improvement of medical care in hospitals. To avoid effects of large burst data from PACS on other traffics such as data from hospital information systems (HIS) and radiology information systems (RIS), the bandwidth of the network for PACS service has been considered to be crucial. Thus, hospitals usually introduced high-grade network equipments to support PACS service. However, the necessity of broad banded intrahospital network is a bottleneck of the spreading of PACS among hospitals because these equipments are expensive and manpower consuming for maintenance.
 In the present study, we analyzed network traffic for several months using SNMP and MRTG (Multi Router Traffic Grapher) in a hospital (having 1,000 beds) in which experimental PACS service had been supplied in addition to RIS and HIS (order entry service). The results of the experimental service suggest that the PACS traffic flow fits with the small world model of D. J. Watts. Thus, a suitable intrahospital network using OSPF (open shortest path first) routing protocol was constructed based on the small world model with fixed-port type small layer 3 switches in place of high grade network equipments. Under these conditions, we set 180 PACS clients in the hospital and started the PACS service as a regular service with a Kodak DIRECTVIEW PACS system. At first, we have evaluated time required from the initiation of downloading a DICOM image to the period at which image viewing can be started. Compressed and uncompressed DICOM images of CT and MRI were used for the evaluation. Capacities of the small layer 3 switches were high enough to handle the PACS traffic as revealed by traffic monitoring. The time required for uncompressed DICOM images was significantly shorter than that for the compressed images. Although this may be due to abilities of PACS servers and those of personal computers (PC) used as PACS clients in particular CPU clock and RAM size, the findings indicate that the bandwidth of the network is not a rate-limiting factor for the PACS service under the above-mentioned network conditions. This is in agreement with the data from traffic analysis, and thus, uncompressed DICOM images have been delivered successfully in the hospital.
 On the basis of these findings, we have constructed an intrahospital network for a new hospital (with 600 beds) in which graded-up PACS service is available under film-less conditions with an electronic medical record system (having 730 clients). From the beginning of hospital service, nearly all PACS service using uncompressed DICOM images was started. At 1 month after hospital service started, this delivery service is practical use on clinical service.

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 In the operation of the electronic medical record system in a hospital, it is an important issue to prevent patients’ private information being peeped for purposes other than the original intent. For this purpose, approaches of the next two steps were carried out. 1) Users of the system were informed that the browsing record of patients’ medical records will be audited. 2) The access history of the personal information of patients who were staffs were notified to the individual users by E-mail monthly. As a result, the numbers of the users who browsed the medical records of patients who were staffs were decreased. Since it is difficult to judge the purpose of access by the browsing record, this method remains insufficient for purpose of automatic audit. However, it is thought that this method is effective to call attention to the protection of patients’ personal information.

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 In Japan, we have many kinds of educational facilities in nursing. Unfortunately, however, we do not have any dynamic statistics about nurses. This study was conducted to make clear how nurses work as a nurse. This paper will focus on trends of educational background of nurses. Education and career records of all nurses in Nagano Prefecture were surveyed. 10,021 out of 18,042 questionnaire were collected, and its response rate was 56%. 9,477 responses, which were filled with full history of education, were used for the purpose of this study. 7,548 respondents were RN, and 1,929 were LPN. There are several ways to get RN and LPN in Japan. We can obtain LPN through 2-year course after graduating from junior high school. 9.5 percent of all respondents were junior high basis nurses. Using logistic regression model, it was found that the distribution of educational background varied in terms of their age. For instance, there were scarcely junior-high-basis nurses in younger generation. However over age of fifty, more than 20% of nurses were junior-high-basis. From such point of view, if we have data about educational history of nurses, we are able to not only make clear the discrepancy among age groups, but also plan effective continuing education and educational strategy.

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 Although many significant information data is in a medical-supplies appending document, it is not separable as a keyword. Furthermore, those terms are not coded in the computer system. We extracted the medicinal keyword from appending document data using the morphological-analysis technique, and classified the word. These are expected contributing beneficially in a hospital information system.

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 Compare with a nurse and maternity nurse, a public health nurse’s sphere of nursing activities is wide, and the object of nursing is various. So, it is important to have capability that grasp the current situation, problem analysis, and considers the next action. In addition, the information literacy capability for performing these efficiently is also required.
 Therefore, in order to make these master, I invented the new program of the health statistic exercise which took in epidemiology, public health, information science, and medical informatics.
 And I utilized multimedia and network positively to perform this exercise effectively. Especially, in order to make Web distribution of teaching materials easily and improve communication with a student on Web, I built a Web server with a system of “Wiki” to enable making / editing of a Web page on a Web browser.
 In this paper, I presented that it was suggested that exercise by this program is effective for education of public health nurse by a result of a student questionnaire when I carried out this exercise for two years.

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